PUVA-bath photochemotherapy and isotretinoin in sclerodermatous graft-versus-host disease.
Chronic graft-versus-host disease (GVHD) is almost always associated with skin diseases appearing either as lichenoid GVHD, sclerodermatous GVHD (sGVHD) or as eosinophilic fasciitis-like disease. The two latter frequently result in severe and deep sclerosis. Immunosuppressive therapy is of little help in sclerodermatous or eosinophilic fasciitis-like types of GVHD. Based on data showing that PUVA-bath photochemotherapy is effective in the treatment of severe localized sclerosis of the skin, we investigated the efficacy of PUVA-bath photochemotherapy and isotretinoin in sGVHD. In a retrospective study we analyzed fourteen consecutive patients with sGVHD who received PUVA-bath photochemotherapy, five in combination with oral isotretinoin. Seven patients improved and four showed complete remission. Surprisingly, the therapy was complicated by the development of ulcers within the sclerotic plaques during the early periods of treatment. These ulcers cleared in most patients when PUVA-bath photochemotherapy was continued. Thus, PUVA-bath photochemotherapy alone or in combination with isotretinoin may resolve or improve GVHD associated sclerosis in selected patients.
Ghoreschi
Kamran
K
Department of Dermatology, Eberhard Karls University, Liebermeisterstr. 25, 72076 Tübingen, Germany.
Thomas
Peter
P
Penovici
Marius
M
Ullmann
Johanna
J
Sander
Christian A
CA
Ledderose
Georg
G
Plewig
Gerd
G
Kolb
Hans-Jochem
HJ
Röcken
Martin
M
D000328:Adult; D001494:Baths; D002908:Chronic Disease; D003879:Dermatologic Agents / Q000627:therapeutic use*; D006086:Graft vs Host Disease / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D015474:Isotretinoin / Q000627:therapeutic use*; D008730:Methoxsalen / Q000008:administration & dosage; D008875:Middle Aged; D011701:PUVA Therapy; D017319:Photosensitizing Agents / Q000008:administration & dosage; D012598:Sclerosis; D012867:Skin / Q000473:pathology
D003879:Dermatologic Agents; D017319:Photosensitizing Agents; D015474:Isotretinoin; D008730:Methoxsalen